Organization Climate and Safety Conscious Work Environment

Documents and Forms

Document Name Document Type
Survey - Attachment 3 (Survey).doc Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Organization Climate and Safety Conscious Work Environment	Agency IC Tracking Number:	Mark VanDerPuy

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 10 CFR 63.9

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			Survey - Attachment 3 (Survey).doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,750	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,750	1,750
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.